Is Your Meter Out of Control?

Your doctor probably never told you that you need to check your blood glucose meter regularly with the control solution made for it. The chances are that you don’t use a control solution, and in fact, you may never have heard this term before.

A control solution is a solution that mimics blood and that is used to test the accuracy of a blood glucose meter and test strips, says the Manual for Pharmacy Technicians. It is specific for a particular meter and may come as low, normal, or high control. The solutions can be categorized as “Level 1” or “Level 2,” representing low or high control. The expiration date of the control solution varies by manufacturer and can range from three to six months.

Most Never Use Control Solution

A survey of 18 people in the Bay Area of California who have type 1 diabetes or parents of children with it showed that 58 percent of them never used a control solution. Note well that these are people who rely on insulin, which requires rather precise blood glucose meter readings.

Another survey, “An Evaluation of the Barriers to Patient Use of Glucometer Control Solutions,” this one of people with diabetes in Tulsa, Oklahoma, showed that only 23 percent of the 60 people with diabetes use a control solution. This survey was presented at the 2014 annual meeting of the American Association of Clinical Educators. Two-thirds of the people in the survey said that they didn’t use it because they didn’t know about it.

Almost half – 44 percent -- of the 29 doctors who responded to the survey said they never recommend using a control solution. They aren’t sure that it’s needed with newer blood glucose meters, or they check the meters against the clinic’s instrument, or they didn’t think about it.

We have a big disconnect here between what the organizations and meter manufacturers say to do as this recommendation is funneled down through our doctors to the people with diabetes that it directly affects. To help resolve this issue I turned to two good friends of mine who work on the front lines with us.

A Recommendation to Use Control Solution

The best way to make sure our meter and strips are working properly is to test it against a big lab equipment at the same time, notes Margaret Leesong, a vice president of i-SENS, which makes blood glucose meters and test strips. “But this is not easy for us to do, while control solution testing can be done at home. Aside from any error messages that the meter shows, control solution is the only thing we have to check if we can continue to count on our meter and strips.

“I think that control solution testing is like wearing a seat belt,” Margaret continues. “Even when we are not likely to have an accident, we take precautions.”

A Recommendation to Recheck Blood Glucose Instead

On the other hand, Karen LaVine, a Certified Diabetes Educator in Albuquerque, New Mexico, is less supportive of using a control solution.

“I rarely talk to patients about using a control solution,” she told me. “But I do frequently discuss what to do if someone gets an unexpected blood glucose result.

“I recommend the following steps,” Karen continues. “Recheck your blood glucose, following the recommended procedure exactly. Wash hands well (even if it's a second time), dry with clean paper towel, put fresh lancet into lancet device, and recheck blood glucose with a fresh strip, being careful to obtain an adequately sized sample easily. If the second reading is significantly different from the initial reading, then recheck your blood glucose one more time to help estimate your current blood glucose.

“Having to use two to three strips occasionally is almost always going to be a lot quicker than fiddling with a control solution. That's because once you open a bottle of control solution, it's only good for three months. So if you get a questionable blood glucose result and want to run a control test, your current bottle is highly likely to be expired.”

Karen’s conclusion is that for patients testing at home the use of a control solution could be helpful only very rarely. I tend to agree, but think that some people will benefit from using it in some situations.

When a doctor told me almost 22 years ago that I have diabetes, he didn’t even mention that such a thing as a control solution for blood glucose meters exist. In the many years since then no doctor or other medical professional who I have seen as a patient has ever said anything either. Maybe this is because I have never used insulin.

Should People on Insulin Use Control Solution?

After considering all aspects of this knotty situation, my feeling it that I don’t think that we should go to extremes and say that everyone who has diabetes needs to check his or her blood glucose meter in all of or even most of these situations.

But certainly all people who uses insulin to manage their diabetes have to be sure that the blood glucose meter they use is reasonably accurate because too much insulin can lead to a dangerous low blood glucose level and too little to a dangerous high blood glucose level. Those of us who rely on insulin do need to be sure that the blood test results they get are as accurate as possible.

I’m not so sure about the rest of people with type 2 diabetes who aren’t on insulin. Does anyone with diabetes who is reading this far and isn’t on insulin regularly use a control solution with his or her blood glucose meter?